中性粒细胞/淋巴细胞比值对微小病变型肾病发生激素性骨坏死的预测价值

目的　探讨中性粒细胞与淋巴细胞的比值（NLR）预测微小病变型肾病（MCD）患者发生激素性骨坏死的价值。方法　回顾性分析经皮肾穿刺活检术诊断的329例MCD患者的临床资料。根据受检者工作特征（ROC）曲线确定NLR诊断MCD发生激素性骨坏死的最佳截断值，以截断值为界将研究对象分为低NLR组（NLR≤3.321）262例和高NLR组（NLR＞3.321）67例，比较2组患者的基线临床指标、激素用量及时间、合用钙剂及活性维生素D3情况，分析NLR与MCD患者发生激素性骨坏死的相关性，以Kaplan-Meier生存曲线比较2组患者的关节生存率；以多因素Cox回归模型分析MCD患者发生激素性骨坏死的危险因素。结果　全部患者的总中位随访时间为38个月。高NLR组的年龄、白细胞计数、单核细胞计数、C反应蛋白、红细胞沉降率、纤维蛋白原、骨钙素、β胶原特殊序列、血尿素氮、血肌酐及发生激素性骨坏死的比例均较低NLR组高，估算肾小球滤过率较低NLR组降低（P＜0.05）。Kaplan-Meier生存曲线显示，低NLR组患者的关节累积生存率明显高于高NLR组（c2=10.130，P＜0.01），高NLR组与低NLR组的1年、3年、5年生存率分别为82.9% 和93.5%、76.3%和88.9%、65.2%和85.6%。多因素Cox回归分析结果显示，高NLR水平是MCD患者发生激素性骨坏死的独立危险因素（HR=2.155，95%CI：1.136～4.089，P＜0.05）。结论　血NLR水平与MCD患者发生激素性骨坏死的风险相关，可作为评估MCD患者发生激素性骨坏死风险的有价值指标。

The value of the ratio of neutrophil to lymphocyte in predicting glucocorticoid induced osteonecrosis in minimal change disease

Objective　To investigate the value of the ratio of neutrophils to lymphocytes (NLR) in the prediction of glucocorticoid induced osteonecrosis in patients with minimal change disease (MCD). Methods　A total of 329 MCD patients diagnosed by percutaneous renal biopsy were retrospectively analyzed. According to receiver operating characteristic(ROC) curve, the best cutoff value of NLR for diagnosing steroid induced osteonecrosis in MCD was determined. The subjects were divided into low NLR group (NLR ≤ 3.321, n=262) and high NLR group (NLR > 3.321, n=67). The baseline clinical indicators, hormone dosage and time, combined use of calcium and active vitamin D3 were compared between the two groups. The correlation between NLR and steroid induced osteonecrosis in MCD patients was analyzed. The joint survival rate was compared by Kaplan Meier survival curve between the two groups. Multivariate Cox regression model was used to analyze the risk factors of steroid induced osteonecrosis in patients with MCD. Results　 The median follow-up time for all the patients was 38 months. The age, white blood cell count, monocyte count, C-reactive protein, erythrocyte sedimentation rate, fibrinogen, osteocalcin, β-CTX, blood urea nitrogen, serum creatinine and the proportion of osteonecrosis were significantly higher in the high NLR group than those in the low NLR group (P＜0.05). The eGFR was significantly lower in the high NLR group than that in the low NLR group (P＜0.05). Kaplan-Meier survival curve showed that the joint survival rate was significantly higher in the low NLR group than that of high NLR group (c2=10.130, P＜0.01). The 1-year, 3-year and 5-year joint survival rates were 82.9% vs. 93.5%, 76.3% vs. 88.9% and 65.2% vs. 85.6% in the high NLR group and the low NLR group, respectively. Multivariate Cox regression analysis demonstrated that the high NLR level was an independent risk factor for glucocorticoid induced osteonecrosis in MCD patients (HR=2.155, 95%CI=1.136-4.089, P＜0.05). Conclusion　There is a positive correlation between blood NLR level and the risk of glucocorticoid induced osteonecrosis in MCD patients, and NLR could be used as a valuable indicator to evaluate the risk of steroid induced osteonecrosis in MCD patients.